Induction of Meal-related Symptoms as a Novel Mechanism of Action of the Duodenal-Jejunal Bypass Sleeve

Abstract

Background: Treatment with a duodenal-jejunal bypass sleeve (DJBS) induces clinically significant weight loss, but little is known about the mechanisms of action of this device. Aim: The aim of this study was to characterize the mechanisms of action of the DJBS and determine the durability of weight loss and metabolic improvements. Materials and Methods: We studied a cohort of 19 subjects with severe obesity and type 2 diabetes (baseline body mass index: 43.7±5.3 kg/m2). Anthropometry, body composition, blood pressure, biochemical measures, and dietary intake were monitored for 48 weeks after DJBS implantation, and then for 1 year after device removal. Gastric emptying and triglyceride absorption were measured at baseline, 8 weeks after implant, and within 3 weeks of device explant. Visceral sensory function was assessed at baseline, 4 weeks after implant, and within 3 weeks after explant. Results: Significant weight loss (P<0.01) occurred following DJBS placement, with a mean weight reduction of 17.0±6.5% at 48 weeks. The symptom burden following a standardized nutrient challenge was increased after DJBS implantation (P<0.05), returning to baseline after DJBS removal. Neither gastric emptying nor triglyceride absorption changed with the device in situ. A significant reduction in energy intake was observed [baseline: 7703±2978 kJ (1841±712 kcal), 24 weeks: 4824±2259 kJ (1153±540 kcal), and 48 weeks: 4474±1468 kJ (1069±351 kcal)]. After 1 year, anthropometry remained significantly improved, but there was no durable impact on metabolic outcomes. Conclusions: DJBS treatment resulted in substantial weight loss. Weight loss is related to reduced caloric intake, which seems linked to an augmented upper gastrointestinal symptom response, but not altered fat absorption.

Duodenal–jejunal bypass liners are superior to optimal medical management in ameliorating metabolic dysfunction: A systematic review and meta‐analysis

“…Studies included seven randomized controlled trials (RCT), 18 observational studies, one combined observational and retrospective cohort study, one retrospective cohort study, and one retrospective case control study (Table 1). 6,7,10,14,23–46 Data from five studies reporting secondary analysis or long‐term data of patients from the included studies were added to our analysis to supplement outcome data at explant or in post‐explant follow‐up when not reported in the original included study 8,13,47–49 …”

Does Bypass of the Proximal Small Intestine Impact Food Intake, Preference, and Taste Function in Humans? An Experimental Medicine Study Using the Duodenal-Jejunal Bypass Liner

“…Nutrient malabsorption has been proposed as a possible mechanism of weight loss after the Endobarrier, due to the bypass of 60 cm of the small intestine. However, when fat malabsorption was measured using 13 C mixed triglyceride breath test in patients with obesity and T2DM, there was no evidence of reduced intraluminal lipolytic activity suggesting that fat malabsorption does not take place [ 14 ]. Similarly, no evidence of food malabsorption was found in rats treated with an endoluminal sleeve, as measured by the difference in calories consumed and excreted in the stool using direct calorimetry [ 13 ].…”